To feel vindicated by the D of H report, which confirms midwives are withholding epidurals?

[RevolutionofourTime]

www.theguardian.com/lifeandstyle/2020/mar/03/women-in-labour-being-refused-epidurals-official-inquiry-finds

I was denied pain relief during my first labour for no reason whatsoever. When I complained to the head of midwifery, she encouraged me to try a home birth next time. 🤨 I have also witnessed other women in maternity ward being denied pain relief.

Despite this, I have seen it argued here time and again that midwives are not acting as gatekeepers or withholding proper pain relief in labour.

This report confirms what many of us know.

I will be curious to see if this will lead to changes- more specifically, to adherence to the Nice guidelines that it’s never too early and never too late for an epidural in labour.

@Ironytheoppositeofwrinkly really? Why on earth would you be denied anything in that a situation. That's painful on every single level. If you had to go through that I'm so very sorry.

Especially older women. Trying not to be ageist but I really think it's true. Not only with midwives but also with general society and relatives. It needs a societal change.
Also men to a lesser extent but they are rightfully more quiet in their opinions.

My midwive(s), 32 hrs, with DS1 were very reluctant to give me epidural and heavily focusing on the risks of the epidural.
My second DS was a c.section. Due to above pressures I went to great lengths to try to insist on natural (ha!) birth. And nearly died. My relatives still don't think second birth was worthy/ real birth / womanly enough. Struggling to find appropriate word. They say at least I gave birth once (DS1).
'Too posh to push' people are held in deep derision. I think they think I should have held out for a natural birth and not given permission for cs. And if I had died then that's just how it sometimes is.

RevolutionofourTime those entries you have copied have come from different Cochrane reviews investigating different things, I think it would be helpful to include their respective titles.

The first one was looking at the effect of early vs late initiation of epidurals, not measuring epidurals vs other pain relief.

Of course women should feel they have been listened to and have had their choices respected. What must be taken into account though, is that we are giving birth within the NHS. There simply aren't the resources for everyone to have what they want, when they want it.

If a woman at 1cm is requesting an epidural, and at the same time, a baby needs delivering by emergency c section, the anaesthetist will have to attend the emergency case. Everything needs to be prioritised to maintain safety. Resources are not finite, staffing pressures are huge.

A hospital delivery suite simply does not have the space, staffing or resources to provide epidurals to women in the early stages of labour.

There are other ways to manage early labour, an early epidural has so many implications on labour outcomes.

I had an awful experience with pain relief being withheld back in 2017.

I have a condition called congenital coxa valga. The pressure of a baby on my pelvis causes excruciating pain, I can stay still I literally writhe with pain screaming.

My midwife while I was in labour only allowed me to use gas and air during a contraction, she would physically remove the gas and air from me and tell me it doesn't work for pressure I was feeling and that I need to get on with it.

I begged for an epidural for hours and she refused to let me have one. Eventually she gave in, sadly for me i didn't have time for the epidural to even take affect before my baby came. It was horrific the pain I went through.

I found it incredibly difficult to bond with my baby afterwards and I still struggle with that to this day and she's 2!

In addition to the "drastic national shortage of midwives” and "anaesthetists not always available" I reckon its numbers of patients vs numbers of beds also (dependent on where you live obviously).

I'm due to give birth for the first time in 8 weeks, our London hospital can have 10 giving birth in the labour ward at any one time, and 6 in the MLU (went on a tour recently - staff made us aware of this). The population it serves covers 3 London boroughs due to the shut down of 2 other delivery units in the 2 nearest hospitals to this one. MLU (and ergo no epidural access) is highly encouraged in the birth plans of low-risk pregnant women, they want to keep the labour ward free for high-risk pregnancies, inductions and c-sections. I've asked a midwife what would happen if I was in MLU but the pain became too much and I decided I wanted an epidural, but otherwise the labour was progressing well? The midwife said they would put a call into the labour ward (one floor below) to see if a bed and an anaesthetist was free. I have a feeling with 10 beds only the request for an epidural in this scenario would put me to the back of the queue, unless for some bizarre reason the labour ward wasn't that busy? It puts me in a tricky position as, for my first time, I'd like to see what I could do without an epidural, maybe get in the pool, but at the same time I have a feeling my MLU decision (and pain relief options that come with it) would be really final once I went in there (unless I became high risk and ended up transferred anyway).

My MW tried the airy “ oh I’m sure there’s no need” when I asked if it was time for my epidural, despite it being mentioned multiple times on my birth plan and notes
I asked her if she was refusing me one and if so on what grounds. I also asked DH to make a note of the exact time
I had one about 15 minutes later!

Britain has a nasty nasty little fetish.
People seem to love the idea of women suffering in childbirth and will withhold pain relief and push for natural birth and other goddessy nonsense.

I was nearly denied an epidural (when I was 7cm dialated) but after I kicked off, and I kicked off bigtime, an anaesthetist suddenly became available. Says it all really.

I had an epidural at 9cm 6 yrs ago.I couldnt have coped without it.

Now you mention, it did seem like my midwife was trying to scare me out of having an epidural.

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain?

There was a study a while ago which showed women are made to wait for longer than men for pain relief in A&E, even for the same conditions as men (eg heart attack). Particularly true for non white wonen, who also receive lower doses, less often.

Medicine has an appalling attitude towards women on the whole (not all individuals, but the system overall). This is just one area.

@MrsPelligrinoPetrichor

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain?

Same with me - I was miscarrying in inn so much pain and it was so obvious that was what was happening. I was in hospital having a scan and they could not see the baby, or the sac so it was clear that that's what was haappening. The doctor had said I could have endone for pain relief but the nurse on the ward said "why would you want that if you're pregnant" Ah, lady, it's a miscarriage. I think it's just denial of women's opinions on their own bodies and what they need, even if a doctor says to do it, sometimes the nurses won't listen.

Then, they sent me home same day, twice, and the second time ended up haemorrhaging at home and having to go back in an ambulance. I had to have a d&c to remove the placenta properly and a truckload of sweet sweet morphine. The doctor had to explicitly tell them to give me as much relief as I wanted.

This article made me very angry and upset yesterday and bought back some very bad memories!

During my first birth with DC1 I had opted for a homebirth, in hindsight this was a combination of NCT encouraging it (don't hold a grudge about that it was still my decision) but also being massively encouraged to homebirth by the NHS in the borough i was in (SE london) to reduce burden on hospital (this was common knowledge). Anyway my labour was bak to back, I was in it for 24 hours at home with NO pain relief at all, midwife visited and forgot the gas and air (3 x). I was in agony and thought I was dying (contractions regular, less than 10 mins apart). The hospital was full (apparently) so I couldn't go in. I had to wait until I had been in labour for 36 hours before I could get to hospital. Once there I immediately got gas and air (great) and asked for an epidural which was refused because 'I wasn't dilated enough'. At this point I was 3cm. I had to wait in a corridor for 3 hours before I eventually got into a room. A midwife broke my waters to encourage labour and 'turn' my baby. This was agony as I had no pain relief still (despite begging). Eventually my labour stopped at 4cm dilation, after 40 hours my body gave up I guess. At that point I asked for a c-section and was refused, in the end I was given an epidural so that I could sleep because nothing was happening. 8 hours later DC1 arrived fine, epidural was fantastic but the journey to getting it was utter hell.

For DC2 I was living somewhere different (North West) my previous experience was treated with dignity and I was offered ELCS which I took. It wasn't all that smooth but it was handled well, I was given choices and respected for those. In hindsight if I had not had a terrible experience with DC1 i would have 100% opted for a natural delivery for DC2 with a guaranteed epidural had she been back to back as well. I am very sad that I was made to believe I couldn't have an epidural (or anything else!) until 40 hours into labour and that it would INEVITABLY slow things down / lead to various complications.

At the time I thought about complaining about my first midwife who supposedly cared for me for the first 2 days of my labour, I didn't because It's traumatic and I wanted to move on but I do feel the way she practiced did not have my interests at heart.

My friend was denied an epidural. Every time she asked, she was told "later" and then suddenly it was too late! She was traumatized for days but coped well later. Her recovery was super quick and she found comfort in that - so she didn't do a formal complaint. I'm sure there are women who didnt cope or had long term effects of the trauma. Its not about pain relief, its about having that choice at one of the most terrifying times of a woman's life.

I had just gas and air mainly because my grandma said she had an epidural once and found it harder to push the baby out as she couldn't really feel anything from the waist down, so it prolonged her birth, all the other 5 she had natural and said it was easier so I just went on that.

I was fine until the pushing stage and the ring of fire and then I started begging for them to use clamps to pull her out of me instead that's when I started asking for more pain relief (I was water birth too), but they said it was too late, but seen as I was literally at the pushing stage by this point I think it genuinely was!

This is interesting, I was given to believe that you could only have one between 4 and 6cm dilated (that was 12 years ago). So as soon as I got to four cm I requested one, as I was also told they were busy and it might not be available for a while. I did get one. My attitude at the time was I'd have had a general if I could! The underfunding of mat wards and the NHS in general is a disgrace to this government.

Can you think of any other hospital setting where a patient actively has to request pain relief when they are obviously experiencing pain?

No, but then some women don't want the pain relief, and you can't just force it on them so of course they have to ask. It's all about your preferences (or supposed to be!)

I’m so saddened by all the stories here. For those of you who feel able, I would strongly encourage you to google to see if there is a Maternity Voices Partnership in your county, and contact them to tell your story.

Patient engagement is becoming more of a factor in all areas of medicine but especially maternity. Can’t speak for other areas but where I am they do listen to us - we’ve made some absolutely huge changes to our local service over the past couple of years purely because of patient feedback. There’s still an awful lot to do but hearing from the women who’ve been through this is so crucial.

It's not just about pain relief, it's a "midwife knows best" and "nature knows best" doctrine. My experiences with midwives made me suspect two factors at play (though of course that doesn't mean they are the only two).

One is a general idea that "natural is best" and that therefore the ultimate birth to aim for is a drug-free vaginal birth. I think this is a hangover from the backlash against over-medicalised births several decades ago and I agree they were over-medicalised, but that doesn't mean natural, vaginal, midwife-led birth suits everyone. Some midwives cling to this like a dogma and that can turn into pressure.

The other is a kind of war between doctors and midwives where midwives will actively contradict and dismiss doctors' advice. Now that might be appropriate sometimes and I understand if more doctors are male and more midwives female they might feel that they understand more. But for some of us, medication and surgery are there for a reason and it's extremely alarming seeing them slip away from you.

I had a CS agreed by a consultant after a previous EMCS, but went into labour before the booked date. I was HEAVILY pressured by several midwives to try for a VBAC and if any probs "we can aways use forceps" . A baby had died from incorrect use of forceps at that hospital not long before. And I already knew I needed a CS as I had a problem dilating and a large-headed baby. This was all on my notes. As was my history of sexual abuse and difficulty with internals. But the midwives' only priority seemed to be a natural birth, as if it was only fair to TRY for that because if I managed it I'd be happier. No, I wouldn't. I'd had a CS before, I needed a CS again and I didn't give a crap about "succeeding" at a VBAC.

The only reason IMO that I argued my case and got my CS is that I'm very assertive, articulate and stubborn. What if I didn't have good english, was easily cowed or had fallen prey to the idea that a CS is some kind of failing? It could have been disastrous.

auslass I'm so sorry that happened ,truly awful.

Can you imagine the fuss if a dentist decided to pull a tooth out without proper pain meds just because they thought they knew better and you should put up with the pain?!

This has been happening for many years. In 1995 having been in labour for 7 hours, I asked for pain relief. I was told I was too late for pethidine or an epidural. 6 hours later a Dr finally saw me agreed to the pethidine without me asking. The midwives' attitude just seemed so callous and I did feel traumatised afterwards to the extent I had flashbacks that night.
3 years later I was in labour again but when I asked for an epidural I was told I couldn't have one as all the anaesthetists were busy. I gave birth 5 very painful hours later. I believed what the midwife said at the time but now wondering if it was a good way of stopping me having an epidural.

The underfunding of mat wards and the NHS in general is a disgrace to this government

Thing is though people are left until the situation becomes an urgent one or even an emergency one. At that point you end up surrounded by people. How come all those people are suddenly available but 1 wasn't previously to prevent it getting to that point.

Doesnt really make sense

I think the sad thing is that the aim is really just to get through with mother and baby alive rather than for a 'good birth' where the mother is treated as a human

Having said that though I did have a couple of great midwives at various points - just not at that birth. One of the best was a Danish woman with a much more balanced attitude. Another who was there during my first labour was just very empathetic and caring and listened to what I wanted and needed. She also came to visit me on the ward after the CS and was hugely reassuring - just a lovely woman.

As in any field there is a mainstream culture but it's not everyone.

I had a midwife lecturing me on why I was opting for a c section (I explained that I’d experienced traumatic gynae procedures and she said she didn’t believe me - apparently having endometriosis never includes traumatic gynae procedures!), and telling me about how bad c sections are for mum and baby, all the complications and risks.

As she was doing this, a consultant and someone else were doing scan. 30 seconds after the lecture ended, the consultant told me one of my twins had stopped moving and I needed an emcs right now.

I wanted to punch that MW to be honest. She scared the shit out of me. Looking back it had been very clear for a while (to the staff) that I would need a cs. I still don’t know what she thought she was playing at.